Provider Demographics
NPI:1275582991
Name:KHAN, DAUD Y (DO)
Entity Type:Individual
Prefix:DR
First Name:DAUD
Middle Name:Y
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DAUD
Other - Middle Name:YUSUF
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:113 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1705
Mailing Address - Country:US
Mailing Address - Phone:417-347-2476
Mailing Address - Fax:
Practice Address - Street 1:113 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1705
Practice Address - Country:US
Practice Address - Phone:417-347-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8477207P00000X, 207R00000X
MO2000158729207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100394030CMedicaid
MO245291703Medicaid
P00248175OtherRR MEDICARE
OK100216740AMedicaid
MO143100OtherANTHEM
MO003014713Medicare PIN
MO245291703Medicaid